If your doctors or First Medical make a decision about your care that you don’t agree with, you can file an appeal. When you appeal, you’re asking First Medical to take another look at a mistake you think was made.
If First Medical denies, reduces limits, suspends, or ends your health care services, they will send you a letter in the mail. The letter will have information like:
- What decision First Medical made
- Why they made the decision
- How to file an appeal
If you don’t agree with the decision, you can file an appeal. You have sixty (60) calendar days from the date of the letter to file an appeal. Your doctor or your representative can file the appeal for you if you authorize them to do so.
There are many ways to file an appeal. You can:
- Call First Medical at 1-844-347-7800; TTY/TDD users should call 1-844-347-7805
- Visit any of First Medical Service Offices
- Mail First Medical your appeal at:
First Medical Health Plan, Inc.
Grievance and Appeals Department- FM Vital
PO Box 195079
San Juan, PR 00919-5079